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Arthroplasty (London, England) Feb 2021Methyl methacrylate (MMA) is commonly used in the fields of dentistry and orthopaedic surgery. However, there remain concerns for the occupational hazards of MMA,... (Review)
Review
INTRODUCTION
Methyl methacrylate (MMA) is commonly used in the fields of dentistry and orthopaedic surgery. However, there remain concerns for the occupational hazards of MMA, particularly during pregnancy and breastfeeding.
METHODS
We performed a systematic review of studies on effects that MMA may have in pregnancy in the context of exposure during orthopaedic surgery and dentistry. Review articles, studies lacking statistical data, single case reports and other evidence level V studies were excluded.
RESULTS
Nine studies were included. One basic science study demonstrated an increase in neuronal cell lysis and shrunken cell bodies when neocortical neurons were exposed to MMA monomer. Three animal studies exposed pregnant rodents to MMA via intraperitoneal injection or inhalation. Exposed fetuses in two studies had an increase in gross abnormalities such as hemangiomas, while there was no increase in teratologic effects in the third study. In dental workers exposed to MMA, two retrospective cohort studies did not find a statistically significant increase in birth defects or miscarriage. After exposure to MMA during total joint arthroplasty, two studies found that MMA levels were undetectable in the mothers' serum or breast milk. One study measuring the airborne levels of MMA during simulated joint arthroplasty found that concentrations never exceeded 1% of the recommended limit set forth by the Occupational Safety and Health Administration (OSHA).
CONCLUSIONS
Potential teratologic effects of MMA cannot be excluded by existing evidence. However, the typical MMA exposure levels for dental and orthopaedic personnel appear to be substantially less than currently proposed exposure limits.
PubMed: 35236460
DOI: 10.1186/s42836-020-00059-z -
Journal of Neurosurgery. Spine Dec 2022The purpose of this study was to describe the genesis of the AO Spine Sacral and Pelvic Classification System in the context of historical sacral and pelvic grading... (Review)
Review
OBJECTIVE
The purpose of this study was to describe the genesis of the AO Spine Sacral and Pelvic Classification System in the context of historical sacral and pelvic grading systems.
METHODS
A systematic search of MEDLINE, EMBASE, Google Scholar, and Cochrane databases was performed consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all existing sacral and pelvic fracture classification systems.
RESULTS
A total of 49 articles were included in this review, comprising 23 pelvic classification systems and 17 sacral grading schemes. The AO Spine Sacral and Pelvic Classification System represents both the evolutionary product of these historical systems and a reinvention of classic concepts in 5 ways. First, the classification introduces fracture types in a graduated order of biomechanical stability while also taking into consideration the neurological status of patients. Second, the traditional belief that Denis central zone III fractures have the highest rate of neurological deficit is not supported because this subgroup often includes a broad spectrum of injuries ranging from a benign sagittally oriented undisplaced fracture to an unstable "U-type" fracture. Third, the 1990 Isler lumbosacral system is adopted in its original format to divide injuries based on their likelihood of affecting posterior pelvic or spinopelvic stability. Fourth, new discrete fracture subtypes are introduced and the importance of bilateral injuries is acknowledged. Last, this is the first integrated sacral and pelvic classification to date.
CONCLUSIONS
The AO Spine Sacral and Pelvic Classification is a universally applicable system that redefines and reorders historical fracture morphologies into a rational hierarchy. This is the first classification to simultaneously address the biomechanical stability of the posterior pelvic complex and spinopelvic stability, while also taking into consideration neurological status. Further high-quality controlled trials are required prior to the inclusion of this novel classification within a validated scoring system to guide the management of sacral and pelvic injuries.
Topics: Humans; Retrospective Studies; Sacrum; Pelvic Bones; Fractures, Bone; Pelvis; Spinal Fractures
PubMed: 35907199
DOI: 10.3171/2022.5.SPINE211468 -
Arthroplasty (London, England) Jun 2023Machine learning is a promising and powerful technology with increasing use in orthopedics. Periprosthetic joint infection following total knee arthroplasty results in... (Review)
Review
BACKGROUND
Machine learning is a promising and powerful technology with increasing use in orthopedics. Periprosthetic joint infection following total knee arthroplasty results in increased morbidity and mortality. This systematic review investigated the use of machine learning in preventing periprosthetic joint infection.
METHODS
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed was searched in November 2022. All studies that investigated the clinical applications of machine learning in the prevention of periprosthetic joint infection following total knee arthroplasty were included. Non-English studies, studies with no full text available, studies focusing on non-clinical applications of machine learning, reviews and meta-analyses were excluded. For each included study, its characteristics, machine learning applications, algorithms, statistical performances, strengths and limitations were summarized. Limitations of the current machine learning applications and the studies, including their 'black box' nature, overfitting, the requirement of a large dataset, the lack of external validation, and their retrospective nature were identified.
RESULTS
Eleven studies were included in the final analysis. Machine learning applications in the prevention of periprosthetic joint infection were divided into four categories: prediction, diagnosis, antibiotic application and prognosis.
CONCLUSION
Machine learning may be a favorable alternative to manual methods in the prevention of periprosthetic joint infection following total knee arthroplasty. It aids in preoperative health optimization, preoperative surgical planning, the early diagnosis of infection, the early application of suitable antibiotics, and the prediction of clinical outcomes. Future research is warranted to resolve the current limitations and bring machine learning into clinical settings.
PubMed: 37316877
DOI: 10.1186/s42836-023-00195-2 -
Archives of Orthopaedic and Trauma... Oct 2021Until now, the use of telemedical applications in orthopedics was limited to sparsely populated countries. However, due to the SARS-CoV-2 pandemic, interest in...
PURPOSE
Until now, the use of telemedical applications in orthopedics was limited to sparsely populated countries. However, due to the SARS-CoV-2 pandemic, interest in orthopedics in these procedures has increased significantly. The aim of this systematic review was to find out to what extent there is scientific evidence for the use of telemedicine in the orthopedic field.
METHODS
A systematic literature search was carried out in various databases on randomized controlled trials (RCTs) on telemedical applications in orthopedics.
RESULTS
Altogether, 14 articles were identified that reported about a total of eight RCTs of telemedical applications in orthopedics. Two RCTs were about a patient-to-doctor video consultation and six RCTs were about telerehabilitation after knee and hip arthroplasty (4 × knee arthroplasty, one hip and knee arthroplasty, one hip arthroplasty). For the majority of outcome parameters evaluated, there were no significant differences between the study groups. The cost effectiveness of videoconsultations depended on the workload (number of patient consultations) as well as the effectiveness of telerehabilitation on the distance of the patient's home to the health care center (30 km round-trip).
CONCLUSION
There is sufficient evidence to recommend the use of telemedical methods in orthopedics. However, more research is necessary to further expand the possibilities of telemedical methods with regard to physical examination.
Topics: COVID-19; Humans; Orthopedic Procedures; Orthopedics; SARS-CoV-2; Telemedicine
PubMed: 33635399
DOI: 10.1007/s00402-021-03788-1 -
Journal of Orthopaedics 2021Simultaneous bilateral unicompartmentsl knee arthroplasty (BUKA) is considered safe and effective. We performed a systematic review to assess the postoperative outcomes. (Review)
Review
PURPOSE
Simultaneous bilateral unicompartmentsl knee arthroplasty (BUKA) is considered safe and effective. We performed a systematic review to assess the postoperative outcomes.
METHODS
The US National Library of Medicine (PubMed/MEDLINE), Google Scholar, and the Cochrane Database of Systematic Reviews were queried for publications.
RESULTS
Ten articles were included with 765 simultaneous BUKA. Overall complication rate was 7.0%, survivorship was 97.6% at mean 17 months follow-up. No differences were reported between simultaneous and staged BUKA.
CONCLUSION
Simultaneous BUKA is as safe as staged BUKA, it is associated with decreased length of stay and operative time, although it has an increased rate of blood transfusion.
PubMed: 33679029
DOI: 10.1016/j.jor.2021.02.019 -
International Journal of Molecular... Dec 2023There is increasing interest in using magnesium (Mg) alloy orthopedic devices because of their mechanical properties and bioresorption potential. Concerns related to... (Review)
Review
Magnesium Alloys in Orthopedics: A Systematic Review on Approaches, Coatings and Strategies to Improve Biocompatibility, Osteogenic Properties and Osteointegration Capabilities.
There is increasing interest in using magnesium (Mg) alloy orthopedic devices because of their mechanical properties and bioresorption potential. Concerns related to their rapid degradation have been issued by developing biodegradable micro- and nanostructured coatings to enhance corrosion resistance and limit the release of hydrogen during degradation. This systematic review based on four databases (PubMed, Embase, Web of Science™ and ScienceDirect) aims to present state-of-the-art strategies, approaches and materials used to address the critical factors currently impeding the utilization of Mg alloy devices. Forty studies were selected according to PRISMA guidelines and specific PECO criteria. Risk of bias assessment was conducted using OHAT and SYRCLE tools for in vitro and in vivo studies, respectively. Despite limitations associated with identified bias, the review provides a comprehensive analysis of preclinical in vitro and in vivo studies focused on manufacturing and application of Mg alloys in orthopedics. This attests to the continuous evolution of research related to Mg alloy modifications (e.g., AZ91, LAE442 and WE43) and micro- and nanocoatings (e.g., MAO and MgF2), which are developed to improve the degradation rate required for long-term mechanical resistance to loading and excellent osseointegration with bone tissue, thereby promoting functional bone regeneration. Further research is required to deeply verify the safety and efficacy of Mg alloys.
Topics: Magnesium; Orthopedic Procedures; Orthopedics; Osteogenesis; Alloys
PubMed: 38203453
DOI: 10.3390/ijms25010282 -
Journal of Orthopaedic Surgery and... Feb 2022This systematic review evaluated the clinical outcomes of hardware-free MPFL reconstruction techniques in patients with recurrent patellofemoral instability, focusing on... (Review)
Review
PURPOSE
This systematic review evaluated the clinical outcomes of hardware-free MPFL reconstruction techniques in patients with recurrent patellofemoral instability, focusing on patient-reported outcome measures (PROMs), redislocation rate, and complications. The hypothesis was that hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective.
METHODS
This systematic review was conducted following the PRISMA guidelines. PubMed, Scopus, and Virtual Health Library databases were accessed in October 2021. All the clinical studies investigating the efficacy and feasibility of hardware-free MPFL reconstruction were screened for inclusion. Only studies with a minimum 24-month follow-up were considered eligible. Kujala Anterior Knee Pain Scale improvement and redislocation rate after surgical treatment were evaluated as primary outcomes. The rate of postoperative complications was evaluated as a secondary outcome. The quality of the methodological assessment was assessed using the Modified Coleman Methodology Score.
RESULTS
Eight studies were included in the present systematic review. The quality of the methodological assessment was moderate. Short- to long-term improvement of Kujala score was observed in all included studies. Mean score improvement ranged from + 13.2/100 to + 54/100, with mean postoperative scores ranging from 82/100 to 94/100. Patellar redislocation was observed in 8.33% (8 of 96) patients.
CONCLUSION
Hardware-free MPFL reconstruction with or without associated soft-tissue or bony realignment procedures provided reliable clinical improvements and was associated with a low rate of redislocation in patients with recurrent patellofemoral instability. Advantages such as safety, femoral physis preservation, and comparable complication profiles with implant-based techniques endorse its implementation. Orthopedic surgeons in cost-sensitive environments may also benefit their patients with lower costs, no need for implants, lack of implant-related complications, or surgery for implant removal.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Joint Instability; Ligaments, Articular; Orthopedic Procedures; Patella; Patellar Dislocation; Patellofemoral Joint; Postoperative Complications
PubMed: 35193641
DOI: 10.1186/s13018-022-03008-5 -
The Knee Mar 2023The purpose of this systematic review was to evaluate outcomes and complications rates between inlay and onlay patellofemoral arthroplasty (PFA). (Review)
Review
PURPOSE
The purpose of this systematic review was to evaluate outcomes and complications rates between inlay and onlay patellofemoral arthroplasty (PFA).
METHODS
According to the PRISMA statement, 42 studies with 2552 patients were included. Data considered for quantitative analysis consisted of the Knee Society Score (KSS), the range of motion (ROM), the visual analogue score (VAS), and the Western Ontario and McMaster Universities questionnaire (WOMAC). Complications and revision surgery were considered.
RESULTS
Data on postoperative KSS showed no differences between the groups. The ROM was evaluated in 8 studies for 70 and 331 inlay and onlay PFA, respectively. Onlay group was favorable in terms of postoperative ROM. Postoperative VAS was available for 64 inlay and 110 onlay and no differences were found. Data on postoperative WOMAC were available for 49 inlay and 527 onlay PFA and inlay group showed better scores. A statistically significant higher rate of instability, persistent pain, malposition, stiffness, deep infection, disease progression, and wear of the patellar component were noted in the inlay group. A higher rate of lateral release was noted in the onlay group. A higher number of manipulations under anesthesia was noted in the inlay group. The revision to total knee arthroplasty was reported more frequently in the inlay group.
CONCLUSION
A higher rate of conversion to total knee arthroplasty and complication rates after inlay technique was found. The potential of achieving better WOMAC scores with the inlay technique should be weighed against the higher complication and revision rates compared to the onlay technique.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Knee Prosthesis; Treatment Outcome; Osteoarthritis, Knee; Arthroplasty, Replacement, Knee; Patella; Knee Joint
PubMed: 36680866
DOI: 10.1016/j.knee.2023.01.001 -
Journal of Children's Orthopaedics Dec 2022To evaluate the available literature for postoperative fracture rates following implant removal in the pediatric population. (Review)
Review
OBJECTIVES
To evaluate the available literature for postoperative fracture rates following implant removal in the pediatric population.
METHODS
A systematic review of articles in the PubMed and Embase computerized literature databases from January 2000 to June 2022 was performed using PRISMA guidelines. Randomized controlled trials, case-control studies, cohort studies (retrospective and prospective), and case series involving pediatric patients that included data on fracture rate following removal of orthopedic implants were eligible for review. Two authors independently extracted data from selected studies for predefined data fields for implant type, anatomic location of the implant, indication for implantation, fracture or refracture rate following implant removal, mean time to implant removal, and mean follow-up time.
RESULTS
Fifteen studies were included for qualitative synthesis. Reported fracture rates following implant removal vary based on several factors, with an overall reported incidence of 0%-14.9%. The available literature did not offer sufficient data for conduction of a meta-analysis.
CONCLUSION
Our systematic review demonstrates that fracture following implant removal in pediatric patients is a relatively frequent complication. In children, the forearm and femur are the most commonly reported sites of fracture following removal of implants. Traumatic fractures treated definitively with external fixation have the highest reported aggregate rate of refracture. Knowledge of the incidence of this risk is important for orthopedic surgeons. There remains a need for well-designed studies and trials to further clarify the roles of the variables that contribute to this complication.
PubMed: 36483642
DOI: 10.1177/18632521221138376 -
Journal of Patient-reported Outcomes Apr 2022The Patient-Reported Outcomes Information System (PROMIS®) is more and more extensively being used in medical literature in patients with an orthopedic fracture. Yet,... (Review)
Review
BACKGROUND
The Patient-Reported Outcomes Information System (PROMIS®) is more and more extensively being used in medical literature in patients with an orthopedic fracture. Yet, many articles studied heterogeneous groups with chronic orthopedic disorders in which fracture patients were included as well. At this moment, there is no systematic overview of the exact use of PROMIS measures in the orthopedic fracture population. Therefore this review aimed to provide an overview of the PROMIS health domains physical health, mental health and social health in patients suffering an orthopedic fracture.
METHODS
This systematic review was documented according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. We searched Embase, Medline, Web of Science Core Collection, and Cochrane Central Register of controlled Trials, CINAHL and Google Scholar in December 2020 using a combination of MeSH terms and specific index terms related to orthopedic fractures and PROMIS questionnaires. Inclusion criteria were available full text articles that were describing the use of any PROMIS questionnaires in both the adult and pediatric extremity fracture population.
RESULTS
We included 51 relevant articles of which most were observational studies (n = 47, 92.2%). A single fracture population was included in 47 studies of which 9 involved ankle fractures (9/51; 17.6%), followed by humeral fractures (8/51; 15.7%), tibia fractures (6/51; 11.8%) and radial -or ulnar fractures (5/51; 9.8%). PROMIS Physical Function (n = 32, 32/51 = 62.7%) and PROMIS Pain Interference (n = 21, 21/51 = 41.2%) were most frequently used questionnaires. PROMIS measures concerning social (n = 5/51 = 9.8%) and mental health (10/51 = 19.6%) were much less often used as outcome measures in the fracture population. A gradually increasing use of PROMIS questionnaires in the orthopedic fracture population was seen since 2017.
CONCLUSION
Many different PROMIS measures on multiple domains are available and used in previous articles with orthopedic fracture patients. With physical function and pain interference as most popular PROMIS measures, it is important to emphasize that other health-domains such as mental and social health can also be essential to fracture patients.
PubMed: 35384568
DOI: 10.1186/s41687-022-00440-3